Sino-Nasal Outcome Test (SNOT-20)

The following questionnaire is intended to help define your symptoms and provide valuable information and insights for your doctor. Answer the questions, rating to the best of your ability the problems you have experienced over the past two weeks. After completing the survey, please print this page and bring it to your appointment.

Consider how severe the problem is when you experience it and how frequently it happens, please rate each item below on how “bad” it is by ticking the radio button that corresponds with how you feel.

Symptom

1

2

3

4

5

Score

Need to blow nose

0

Sneezing

0

Runny nose

0

Cough

0

Post-nasal discharge

0

Thick nasal discharge

0

Ear fullness

0

Dizziness

0

Ear pain

0

Facial pain/pressure

0

Difficulty falling asleep

0

Wake up at night

0

Lack of a good night’s sleep

0

Wake up tired

0

Fatigue

0

Reduced productivity

0

Reduced concentration

0

Frustrated / restless / irritable

0

Sad

0

Embarrassed

0

Final Score: 0

Recommendations:

Score 0 to 10:

No medical action is typically needed. Basic symptoms can be treated with over the counter medication as needed.

Score 11 to 69:

An appointment is recommended. Speak to your Primary Care or ENT for perscription and over the counter medication options.

Score 70 to 100:

An appointment is strongly recommended, treatment may include medication. Possibly a surgical candidate.